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2. Rubber dam Application
Dr. M Arsalan Zubair
MDS Trainee (2nd semester)
Operative Dentistry
Dow Dental College
DUHS

3. Indications for rubber dam placement
• moisture control
• visibility
• patient protection
• patient treatment
Contraindications for rubber dam placement
• Claustrophobic patients
• Asthamatic patient
• Mouth breathers
• Partially erupted or hyperplastic gingiva
• Patients that need anesthesia to tolerate clamp
• Severe crowding
• Epileptic patient

4. Contents
• Armamentarium
• Methods of Application
•Errors during Placement and removal

5. Rubber Dam Sheet
• Light and Dark
• It has shiny and dull surface, dull should face the
occlusal side
• Thick Sheet- class V with butterfly clamps
• Thin Sheet- passing easily into tight contact
Patient Napkin
• Why important????

6. • Ivory- type Stokes-type clamp forceps
• Ivory type- limit rotation of retainer
• stokes type tip design- permits rotations
Rubber dam forceps

7. Lubricant
• Lubrication Of Dam
• Water soluble
• Vaseline should not be used why????
• Rather it can be applied as lubricant
for lips
Rubber Dam holders
• Strap holders
• Woodbury frames
• Frame holders
• Young’s frame
• Nygard-ostby frame
• Materials : Metals and plastic

8. • Teeth themselves or stone cast can
be used
• Rubber dam stamp
• Templates
Hole positioning guides
• Retainers- retract gingival tissue.
• Retainer should contact the tooth
on its four line angles
• The prongs of some retainers are
gingivally directed (inverted)
• Why????
Retainers

9. The jaws of the retainer should not extend beyond the mesial and distal line
angles of the tooth because :
(1) interfere with matrix wedge placement,
(2) gingival trauma
(3) a complete seal around the anchor tooth is more difficult to achieve.
• Wing or wingless Retainer .What is the use???
• Bow Should be tied with floss .Why?????

10. Basic Kit of Retainer should a Student
have with it self
Winged clamps:
• Butterfly-type clamp for anterior teeth
• Universal premolar clamp
• Mandibular molar clamp
• Maxillary molar clamp

11. S-G(Silker-Glickman) Clamp
Indication
• Severe Broken Down tooth
• Placed on a tooth proximal
to the one being treated.

13. Methods of tying floss

14. Rubber dam punch
The rubber dam
punch have:
a) rotating metal
table or anvils
(disk) with holes
of varying sizes
b) a tapered, sharp-
pointed plunger
Ivory type
Hygienic type

15. Rotating Table or Anvils

16. • incisors and mesial surfaces of
canines.
• canine
• posterior teeth
• premolars
• molars
• endodontic therapy
• first premolar to first premolar
• first molar to the opposite lateral
incisor
• anteriorly to include the lateral
incisor on the opposite side of the
arch
• one to two teeth distally, and
extend anteriorly to include the
opposite lateral incisor
• as far distally, and extend anteriorly
to include the opposite lateral
incisor.
• only the tooth to be treated is
isolated
Isolation according to Operation

17. Now Repeat it….
• For the maxillary central incisors. Holes are positioned
approximately 1 inch (25 mm) from the superior border of the
dam
• For the mandibular the posterior anchor tooth that is to receive
the retainer

18. Methods of Placement
• Applying the dam and retainer simultaneously
• Applying the dam before the retainer
• Applying the Dam after the retainer
• Cervical retainer placement
• Substitution of a retainer with a matrix
• Split Dam Technique

19. APPLYING THE DAM AND RETAINER
SIMULTANEOUSLY

20. • Bow being passed through the posterior anchor
hole from the underside of the dam
• Gathering the dam to facilitate placement of the
retainer
• Positioning the retainer on the anchor tooth
• Stretching the anchor hole borders over and
under the jaws of the retainer.

21. Rubber dam, clamp, and frame Dam, clamp, and frame carried to mouth as
one unit and placed
Clamp in place with four-point contact
and rubber tucked under the wings

22. Split Dam Technique
Indication
Insufficient coronal structure Single fix prosthesis
Abutment tooth for bridge Partially erupted tooth
Steps
•Two overlapping holes are punched in the dam
•Cotton roll is placed under the lip in the mucobuccal fold.
•Sheet is stretched over the three tooth, distal side each
•Clamp is placed on one side and other tied with ligature

23. Technique
Two overlapping holes are punched
in the dam.
The rubber dam is stretched over the
tooth to be treated and over one
adjacent tooth on each side. The edge of
the dam is carefully teased through the
contacts on the distal sides of the two
adjacent teeth.

24. APPLYING THE DAM BEFORE THE
RETAINER

25. Applying the Dam after the retainer
After the clamp is placed, the dam is
attached to the frame and gently
stretched over the clamped tooth
with the index finger of
each hand.
The clamp is tested for a secure fit with
gentle finger pressure (alternately) on
the buccal and lingual aspects of the
clamp apron.

26. SUBSTITUTION OF A RETAINER WITH A
MATRIX

27. • Complete preparation of the terminal tooth with
the retainer in place.
• Stretch the dam distally and gingivally as the clamp
is being removed.
• The clamp is removed before placement of the
matrix (Toffelmire)
• To maximize access and visibility the mouth mirror
is used to reflect the dam distally and occlusally

28. Example Isolation: From Molar to
opposite Lateral Incisor

29. Step 1: Testing and
Lubricating the Proximal
Contacts
Step 2: Punching Holes

30. Step 3: Lubricating the Dam Step 4: Selecting the
Retainer

31. Step 5: Testing the Retainer’s
Stability and Retention
Step 6: Positioning the
Dam over the Retainer

32. Step 8: Positioning the
Napkin
Step 7: Applying the
Napkin
Step 9: Attaching
the Frame
Step 10:Passing the Dam through the
Posterior Contact

33. Step11:Applying the Anterior
Anchor (If Needed)
Step 12:Passing the Septa through
the Contacts
without Dental Tape

34. Step 13:Passing the Septa
through the Contacts
with Dental Tape
Step 14:Inverting the Dam
Interproximally

35. Step 15:Inverting the Dam
Faciolingually
Step 16:Confirming Proper
Application of
the Rubber Dam

36. Step 18:Inserting the
Wedges
Step 17: Checking for
Access and Visibility

37. Removal of Rubber Dam
• Step 1: Cutting the Septa Step 2: Removing the
Retainer

38. Step 3: Removing the Dam Step 4: Wiping the Lips
Step 5: Rinsing the Mouth
and Massaging the Tissue
Step 6: Examining the
Dam

39. In Children
• Isolation is from posterior tooth to the canine on
the same side.
• Rubber dam sheet-Small, attach to frame
• Napkin should not be use
• Prongs engaged more gingivally
• Retainers:No. 27 and Ivory No. W14

40. Errors in Rubber dam application
• An off-center dam- occlude the
patient’s nasal airway.
• punched arch form is too small,the
holes are stretched open around the
teeth, permitting leakage
• If the punched arch form is too large-
the dam wrinkles around the teeth and
may interfere with access

41. • Inappropriate retainer: may be too small
(1) Breakage (2) Unstable on the anchor tooth
(3) Impinge on soft tissue (4) Impede wedge placement
• Safe to tissues
• Be careful sheet should not tear
• Scissors can hurt tissue during removal of dam

42. THANK YOU